Quality of life (QOL) assessment of MIP (mitomycin, ifosfamide and cisplatin) chemotherapy in advanced non-small cell lung cancers (NSCLC)

BACKGROUND: Quality of life (QOL) assessment has emerged to measure and quantify the balance between treatment benefit and toxicity, and has a value in predicting response and overall survival in cancer patients. METHODS: From July 1995 to February 1997, 38 symptomatic patients with advanced non-small cell lung cancer (NSCLC) were treated with MIP chemotherapy (mitomycin 6 mg/m2, ifosfamide 3000 mg/m2 and cisplatin 50 mg/m2 on day 1 every 3 weeks). Patients were assessed for QOL including physical well-being, general symptoms and lung cancer-specific symptoms, as well as objective response. RESULTS: The overall response rate was 38.9% (14/36, all were partial response) and the median duration of response was 3.5 months [95% confidence interval (CI) 2.0-4.0]. The median duration of overall survival was 7 months (95% CI 5.9-8.5). The overall improvement of QOL was 58.3% with 21 patients feeling better on treatment. The toxicity of chemotherapy was mild, mainly nausea/vomiting and minimal alopecia. Using multiple clinical predictors of survival (age, histology, stage, performance status), only change of QOL emerged significantly (P = 0.0007). CONCLUSIONS: MIP had an endurable response and low toxicity profile, and provided good QOL. Integral QOL data in our study provided the strong prediction of survival in advanced NSCLC. Further experienced QOL study will provide greatly enhanced outcome data in clinical trials.      

Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study

Background  

Catheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important.     

Genetic and phenotypic diversity among ampicillin-resistant, non-beta-lactamase-producing, nontypeable Haemophilus influenzae isolates.

Levels of genotypic and phenotypic diversity among 23 ampicillin-resistant, non-beta-lactamase-producing (Ampr NBLP) isolates of serologically nontypeable Haemophilus influenzae recovered from the respiratory tract were determined by multilocus enzyme electrophoresis, auxotroph testing in chemically defined media, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis of penicillin-binding proteins (PBPs). Twenty distinctive multilocus enzyme genotypes were identified, among which the average level of genetic diversity per locus was equivalent to that in the species as a whole. Hence, a single, recent origin for Ampr NBLP strains is excluded. Of the growth factors tested, a requirement for methionine was significantly associated with the Ampr NBLP phenotype. In contrast to the relative homogeneity of the PBP profiles of the ampicillin-susceptible strains tested (8 PBPs detected), the PBP profiles of the Ampr NBLP strains exhibited marked heterogeneity (5 to 10 PBPs detected). Care should be taken in interpreting changes in PBP profiles and in associating these profiles with resistance for species such as H. influenzae that demonstrate variability.     

Characterization and clonal distribution of four alleles of the speA gene encoding pyrogenic exotoxin A (scarlet fever toxin) in Streptococcus pyogenes

Streptococcus pyogenes strains producing pyrogenic exotoxin A (scarlet fever toxin) have recently caused episodes of streptococcal toxic-shock-like syndrome (TSLS). We exploited knowledge of genetic diversity and relationships among exotoxin A-producing patient strains provided by multilocus enzyme electrophoresis to select strains for comparative sequencing of toxin genes. Our analysis identified four alleles of speA in natural populations, one of which (speA1) occurs in many distinct clonal lineages and is probably old. Two other alleles (speA2 and speA3), characterized solely by single amino acid substitutions, were each identified in single clones that together have caused the majority of TSLS episodes. It is unlikely that these alleles have had a long association with S. pyogenes clones. A fourth allele (speA4) also is present in a single phylogenetic lineage and is 9% divergent from the other three toxin alleles. An absence of synonomous (silent) nucleotide changes in speA2 and speA3 is unusual and suggests that the allelic variation is not selectively neutral, which implies that the toxins are not functionally equivalent. These results may be important in helping to understand the recent increase in frequency and severity of disease caused by S. pyogenes.     

Psychological adaptation of nurses post-disaster.

Disasters have the potential to cause major disruptions in lifeline services and family support systems. As caregivers, nurses are required to make difficult choices during national emergencies and may be at risk for experiencing psychological distress following a disaster. This study describes the responses of a group of nurses following Hurricane Hugo, and makes recommendations to minimize the stress placed on nurses working in a time of disaster.     

Employee experience of workplace supervisor contact and support during long-term sickness absence

Purpose: Workplace support is an important factor in promoting successful return to work. The purpose of this article is to examine relationships between supervisor contact, perceived workplace support and demographic variables among employees on long-term sickness absence.

Materials and method: Data were collected from 204 public employees at a municipality in Sweden who had been on long term sickness absence (60 days or more) using a 23 question survey instrument that collected information on demographic variables, supervisor contact and perceived workplace support.

Results: Most injured employees (97%) reported having contact with their supervisors during their sickness absence, with a majority (56%) reporting high levels of support, including early (58.6%) and multiple (70.7%) contacts. Most were pleased with amount of contact (68.9%) and the majority had discussed workplace accommodations (68.1%). Employees who self-initiated contact, felt the amount of contact was appropriate, had a personal meeting with their supervisors and discussed workplace adjustments reported experiencing higher levels of support from supervisors.

Conclusions: Employees on long-term sickness absence appreciate contact from their supervisors and this is associated with perceived workplace support. However, the amount and employee experience of this contact is important. It needs to be perceived by employees as supportive, which includes a focus on strategies (e.g., work adjustment) to facilitate a return to work. Supervisor training is required in this area to support the return to work process.

• Implications for Rehabilitation

• Contact and support from workplace supervisors is important to workers on long-term sickness absence.

• Employees appreciate frequent contact from supervisors during long-terms sickness absence.

• Employees appreciate a personal meeting with supervisors and the opportunity to discuss issues related to return to work such as work adjustment.

• Employers should provide training to supervisors on how to communicate and assist employees on long-term sickness absence.